Streams

Bloomberg Pushed New Yorkers on Health, and Often They Pushed Back

Wednesday, October 09, 2013

Life expectancy for New Yorkers has increased over the last dozen years, but it's unclear which deserves more credit: local demographics or Bloomberg's public health initiatives.
(nycmayorsoffice/flickr)

On the November day in 2001 that Michael Bloomberg was elected, two things were in the air, literally and figuratively.

The World Trade Center still smoldered, and wouldn’t be fully extinguished for another month. And tobacco smoke still swirled around the city’s bars, restaurants and other public spaces – despite a partial ban during the Giuliani years. Those two fumes came together, as Dr. Alfred Sommer led Mayor-elect Bloomberg’s search for a health commissioner.

Sommer pre-interviewed Dr. Thomas Frieden, a former Health Department official who had helped control tuberculosis in the city in the 1990s and who was now doing so in India. Sommer asked Frieden what ideas he’d “pitch” to the new mayor, and was surprised when Frieden answered: “tobacco.”

“And I said, ‘Um, Tom, have you heard about 9/11?’” Sommer recounted. “And he said, ‘Oh, yeah, sure, and that’s an issue we have to deal with, but I guarantee that tobacco use is going to kill far more New Yorkers than bioterrorism ever will.’”

Bloomberg bought it. He hired Frieden to crusade against tobacco, raise the stature of the Health Department, and increase its focus on chronic health problems, like diabetes, obesity and heart disease.

As a philanthropist, Bloomberg had been interested in public health for a decade. But as mayor, he was now in a position to take the advice of experts and turn it into law, affecting how millions of people live their lives. As with other issues across the political spectrum, his fortune allowed him to take political risks few others would.

Many of the proposals that endeared Bloomberg to public health advocates often angered the people affected by them, eliciting accusations that he wanted to be the city’s nanny.

Bloomberg has maintained that it's his job us to make people healthier and safer, and he has frequently declared, “Being mayor is about saying, 'No.'”

Shortly after being sworn in as mayor, Bloomberg put Frieden’s tobacco plan into action. He raised taxes on cigarettes and proposed banning all smoking in restaurants and bars.

“The question before us is straightforward: does your desire to smoke anywhere at anytime trump the right of others to breathe clean air in the workplace?” Bloomberg told the City Council hearing in late 2002. “Common sense and common decency demand the following answer: The need to breathe clean air is more important than the license to pollute it.”

Small but vociferous protests did little to stop the smoking ban from passing by an overwhelming margin, and it continues to be popular today, netting the approval of 82 percent of New Yorkers, according to a recent New York Times survey. Smoking rates have declined from 22 percent to 15 percent of the local population over the last decade – a steeper drop than the country as a whole.

Elizabeth Lane, 60, is one of many people who said she thought of Bloomberg as a “dictator” for demonizing tobacco. She smoked for 40 years and tried to quit numerous times. But she was unsuccessful. Banning smoking from public places, raising excise taxes on cigarettes sky-high, creating shocking television ads “that scared me half to death” – all these measures infuriated Lane, who lives in public housing in Harlem.

“If he was in the same room as me, I could’ve choked him, I was so angry at him,” Lane said of Bloomberg. “I said, ‘Can he really tell people what to do and how to do it?’”

After years of needing to “beg, borrow or steal” hundreds of dollars a month for cigarettes, after unrelenting pressure from her family and much time spent in prayer, Lane dug out an old nicotine patch she had received from a city-state giveaway years earlier, but never used. It worked. She says she can now walk up stairs without losing her breath and no longer stinks of cigarettes. And she is hopeful she will not need vascular surgery to insert a stent, something that would have cost taxpayers thousands of dollars via Medicaid.

Curtailing smoking has been Bloomberg’s signature public health achievement. Other areas around the world have followed New York’s lead, and local polls suggest it remains hugely popular in the city. But the dramatic success decreasing smoking has been difficult to replicate. On more widespread and complicated problems, progress has been more incremental.

For example, the city’s most visible, extensive and sustained public health campaign has focused on improving nutrition to reduce the risk of obesity, diabetes and other health problems related to weight gain. Among other things, the Bloomberg administration has banned transfats in food service establishments; required them to post calories; encouraged greenmarkets and produce carts; advertised aggressively against overeating; and started the country’s first large-scale registry of individual diabetics.

But while there has been some drop in the rate of obesity among school-age children, adult waistlines have continued to expand.

After years attempting to reform New Yorkers’ appetites, Bloomberg and Frieden’s successor, Dr. Thomas Farley, decided to try something new. Efforts to raise taxes on soda had failed, and the federal government refused to disqualify certain unhealthy foods from the Supplemental Nutrition Assistance Program, better known as food stamps.

So the administration decided to try something no one else had before: limit portion size. Health officials said soda and other sugary beverages were uniquely unhealthy, because they not only are highly caloric but they don’t satisfy the appetite, so consumers keep drinking.

“Compared to smoking, this is an easy battle to win,” the mayor said, when the proposal was announced, “and no one’s going to stop this.”

But Bloomberg clearly touched a nerve.

He and his aides tried to argue that people could buy as much soda as they wanted, that the new rule would simply “reset the default” size, back to 16 ounces, basically forcing people to pause for just a moment before gulping down hundreds of calories. But opponents, backed by the food and beverage industries, assembled a coalition that included store owners –who were exempt from the law and perhaps could even benefit from it – and some politicians representing minority communities. They quickly got the label “soda ban” to stick.

Six in 10 New Yorkers oppose Bloomberg’s sugary beverage initiative, according to a New York Times survey. Two state courts so far have rejected the proposal, not because the city lacks the authority to regulate portion size, but because the mayor, in the judges’ interpretation of state law, cannot create such a law without going through the City Council.

One more appeal is pending, but after nearly a dozen years of challenging New Yorkers on health, Bloomberg may have met his Waterloo. Biographer Joyce Purnick said the backlash was a form of “Bloomberg fatigue.”

“It was the third term, and here he was doing it again,” Purnick said. “Beyond the opposition of the beverage industry, beyond the concept of ‘don’t you tell me what to do with my body,’ I also think that it was, ‘Enough already. You’ve done this too many times. I’m getting sick of you. I’m getting sick of your policies. Leave me alone.’”

Republican mayoral candidate Joe Lhota has said he drop would the legal case and abandon the soda rule. His opponent, Democrat Bill de Blasio, has said on this issue he supports Bloomberg.

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